Obesity is recognized as a chronic disease by numerous organizations globally. However, societal stigma often attributes obesity to individual choices, leading to negative stereotypes and discrimination. This weight-related stigma negatively impacts mental wellbeing in people with obesity, causing psychological distress, social isolation, and avoidance of healthcare. The COVID-19 pandemic potentially exacerbated these issues due to increased media coverage linking obesity to severe COVID-19 outcomes, often using stigmatising language and promoting a blame culture. This heightened stigma posed an additional risk to the mental wellbeing of individuals with obesity. The media’s influential role in shaping social norms and beliefs makes it a crucial factor in understanding the relationship between media representation, weight-related stigma, and mental wellbeing. Loneliness, potentially amplified by pandemic restrictions, may moderate this relationship. This study aimed to investigate the association between perceived media representation of obesity and mental wellbeing during the pandemic, considering the potential moderating role of loneliness in a large sample of individuals with obesity across ten European countries. The researchers hypothesized that the negative relationship between perceived weight-related stigma and mental wellbeing would be stronger in those experiencing higher levels of loneliness.

Existing literature extensively demonstrates the detrimental effects of weight-related stigma on mental health outcomes in people with obesity, including increased psychological distress, social isolation, and reduced engagement in health-promoting behaviors. Studies have highlighted the role of the media in perpetuating these negative perceptions through stereotypical portrayals and reinforcing societal biases. The COVID-19 pandemic provided a unique context, as increased media focus on the link between obesity and COVID-19 severity potentially amplified existing stigma. Research suggests that feelings of loneliness were exacerbated during the pandemic, potentially influencing the impact of stigma on mental wellbeing. However, the precise nature of this interaction remained unexplored prior to this study.

Data were collected from September to December 2020 via the EURopean Obesity Patient PANdemic Survey (EUROPEANS), an online cross-sectional study. Participants (n=2882) self-reported data on demographics, mental wellbeing (WHO-5 Wellbeing Index and PHQ-4), loneliness (De Jong Gierveld short scale), and perceived changes in media representation of obesity. Participants were recruited through various methods, including Qualtrics panels, email invitations, and partnerships with patient advocacy organizations. Eligibility criteria included self-reported BMI ≥ 30 kg/m², age ≥ 18 years, and residency in one of ten specified European countries. Data quality checks were implemented to exclude low-quality responses. Linear mixed-effects models were used to analyze the data, controlling for age, gender, BMI, shielding status, and country. The models examined the associations between perceived changes in media representation (positive, negative, or no change on television and social media) and mental wellbeing outcomes (total distress, anxiety, depression, and wellbeing). Interaction terms were included to assess the moderating effect of loneliness.

The study included 2882 participants, predominantly female (56%) and White or White-mixed (92%), with a mean age of 41 years and BMI of 35.4 kg/m². Compared to pre-pandemic perceptions, perceiving more negative representation of obesity on social media during the peak of the pandemic was significantly associated with higher psychological distress (B = 0.80, 95% CI: 0.42, 1.19), higher depression symptoms (B = 0.50, 95% CI: 0.29, 0.71), higher anxiety symptoms (B = 0.31, 95% CI: 0.10, 0.52), and lower wellbeing (B = -3.52, 95% CI: -6.19, -0.86). In contrast, perceiving more positive representation on television was associated with higher wellbeing (B = 4.52, 95% CI: 2.01, 7.02), but also higher anxiety symptoms (B = 0.26, 95% CI: 0.06, 0.46) and total distress (B = 0.45, 95% CI: 0.09, 0.81). The moderating effect of loneliness was minimal, explaining ≤0.3% of the variance in outcomes. There was marginal evidence that a stronger association existed between positive social media representation and increased depression when loneliness was lower, but this finding was small and inconsistent across outcomes, not justifying conclusions based on it.

The findings support the negative impact of negative media portrayals of obesity on mental wellbeing, particularly from social media. This aligns with previous research showing the link between weight-related stigma and poor mental health. The discrepancy in effects between television and social media may stem from differences in how individuals engage with these platforms. Social media’s interactive nature potentially amplifies the impact of negative representations due to the addition of potentially stigmatising comments. The unexpected association between positive television representation and both improved and worsened mental health outcomes is potentially attributable to increased media coverage of obesity’s link to COVID-19 severity alongside the introduction of obesity support policies. The minimal moderating role of loneliness contrasts with some expectations and aligns with previous research that social support did not moderate the stigma-mental wellbeing relationship. The limitations of the study should be considered, including the cross-sectional design and the self-reported nature of measures.

This study highlights the significant negative influence of negative social media portrayals of obesity on mental wellbeing during the COVID-19 pandemic. While positive television representations showed mixed effects, the importance of responsible media representation is undeniable. Future research could employ longitudinal designs and explore the interplay of loneliness and social support separately. Legislation and stricter regulations to prevent negative and stigmatising portrayals of obesity in the media are encouraged.

The study's cross-sectional design limits causal inferences. The reliance on self-reported data introduces subjective bias. The relatively homogenous ethnic composition of the sample (92% White or White-mixed) limits the generalizability of findings to diverse populations. Reverse causality might explain some observed associations; for example, individuals with poor mental wellbeing may perceive more negative representations than individuals with better mental wellbeing. Finally, the lack of a validated measure of changes in perceived obesity representation in media during COVID-19 necessitated the use of a study-specific question.